By NextBestFitPhase 4: Wave 4: everyone · Step 4.4
Coordinate with continuing payers: workers' comp, auto, VA, TRICARE, IHS
Years 1–4 · UHA; state workers' comp agencies & insurance regulators; VA; Defense Health Agency; IHS & tribesDiscuss this step
Pros & cons of this step
Pros
- +Injured patients get care immediately instead of waiting on liability disputes.
- +IHS gains a new revenue stream for chronically underfunded care.
- +Veterans and military families gain portable coverage without losing VA or military care.
Cons
- −Several payment systems remain, so some coordination-of-benefits administration continues.
- −VA volume may fall as veterans use closer UHP providers, weakening VA's scale in specialized care.
- Keeping workers' comp separate preserves employers' financial incentive for workplace safety but keeps a second administrative system; folding it in would be simpler but remove that incentive.
Trade-off behind each cost item
- Continues as before.
- Continues as before.
- Continues as before.
Trade-off behind each system change
- TRICARE (military dependents & retirees)Simplifies coverage for families; military health leadership loses a large beneficiary population used for medical readiness training.
- Veterans Health AdministrationPreserves VA's specialized care; may reduce VA volume as veterans use UHP providers closer to home.
- Indian Health Service & tribal programsMore money for IHS without disturbing tribal sovereignty; requires consultation under treaty obligations.
- Medicare Secondary Payer rules & coordination of benefitsEliminates most coordination-of-benefits work for providers.
- Workers' compensation medical benefitsKeeps employer liability incentives for safety; some double administration remains.
- Auto insurance personal injury protection & liability medical paymentsPatients never wait on auto insurers to get care.